Reconstructive knee surgery literature as a tool for the orthopaedic in-training examination

The Orthopaedic In-Training Examination (OITE) provides a standardized measure to assess the knowledge of orthopaedic residents regarding knee reconstruction surgery. However, there currently are limited resources for residents who are preparing for the knee reconstruction questions on the OITE. The present study assessed the character of the knee reconstruction questions tested and which literature resources may be recommended for residents preparing for this examination. Materials and Methods: All knee reconstruction-related questions found during a 5-year period (2002 to 2006) on the OITE were characterized by the diagnosis and treatment discussed. The most frequently referenced journals were identified from the OITE exam key. The character of the OITE questions was compared to the literature in terms of overall proportion of articles and questions that were related to knee reconstruction, as well as to categories of diagnosis and treatment modality. Results: There were 59 out of 1375 questions (4%) on the OITE over the 5 years that were related to knee reconstruction. Over half of the questions (54%) were related to primary total knee arthroplasty, with osteoarthritis being the most frequently tested diagnosis (30%). The top three referenced orthopaedic journals were The Journal of Bone and Joint Surgery-American, Clinical Orthopaedics and Related Research, and The Journal of Arthroplasty. Compared to the OITE, these journals covered higher percentages of overall knee reconstruction-related questions (18% versus 4%). In addition, the journal literature had a greater focus on treatment modalities (65% versus 41%) and less emphasis on biomechanics, materials, and basic science (18% versus 34%) than the OITE, respectively. The two most frequently cited textbooks represented approximately 78% of the total number of provided textbook references: Orthopaedic Knowledge Update (39%) and Instructional Course Lectures (39%). Discussion: The results of this study suggest that residents may benefit from using general orthopaedic journals such as The Journal of Bone and Joint Surgery-American in preparation for the OITE. However, residents and residency directors who are preparing their educational programs should be aware that clinical journals may not reflect the OITE in terms of the proportion of basic science and biomechanics articles and additional study resources may be necessary.